August 10, 2016

The release in late June of the Open Payments data for 2015, received very little media coverage but earlier that week Dollars for Doctors dropped a media bomb on the open payments data from the previous year by tying in hospital privileges to open payments. Below are examples of some of the stories that were written.

National

Becker's Hospital CFO did a short bit on the six states where the highest number of physicians accept payments from industry, citing a ProPublica analysis. The article also briefly noted that the analysis revealed some differences based on hospital ownership: for profit hospitals rate was higher compared to other hospitals, included federally owned hospitals (which had the lowest rate).

NPR had a blurb, as part of their "All Things Considered" show, and an accompanying article that discussed the ProPublica analysis overall, picking on doctors affiliated with hospitals in the South and doctors at for-profit hospitals.

Southeast

USA Today picked on a small for-profit hospital on the outskirts of Memphis for their article on the ProPublica Analysis. Three reporters working for the USA Today Network – Tennessee wrote that St. Francis Hospital-Bartlett had the "highest rate of doctors who took payments from the pharmaceutical and medical device industry, out of more than 2,000 hospitals across the nation." The authors do note that there is nothing illegal about taking such compensation, just citing to the "studies" that physicians are more likely to prescribe certain medications than those without relationships. The same article can be found on the website of The Tennessean, part of the USA Today Network.

Mississippi Public Broadcasting wrote an article about how Mississippi doctors are among the top five list for receiving payments from pharmaceutical companies, according to the ProPublica analysis. The article also picks a bit on Louisiana, stating Mississippi and Lousiana tie for third place nationwide for the overall number of doctors receiving payments.

West Coast

Several California publications wrote about the analysis, including the Desert Sun. The article started out with a bold claim about Coachella Valley's hospitals and then gave a brief overview and noted that while this information has been public for quite some time, the recent ProPublica analysis is the first time the various open sources of payments have been used to look for variations between hospitals and doctors.

iNewsSource also covered the ProPublica analysis, explaining the wide variation across the country, with a bit of a focus on San Diego County.

An article on California Healthline covered the ProPublica report, with links to both of the above articles and noting that a hospital's owner is an important factor in whether a doctor meets with industry.

Northeast

An article published in the Boston Globe, stated, "Years after many big academic medical centers cracked down in industry perks, drug companies still regularly buy meals for doctors affiliated with smaller hospitals." This article was based on a new analysis, done by the Globe in coordination with ProPublica, which matched data on company payments to doctors with Medicare data on the primary hospitals physicians were affiliated with that year.

Another article, written for Philly.com, was written on the same analysis, and called out a local cancer center for having a high rate of physicians who work with industry players. The article, to its credit, did also note that some of the hospitals involved did question the data and provided valid reasons for doing so, for example, Crozer-Keystone Health System disputed the number of affiliated doctors attributed to it.

A New England Public Radio blurb focused on physicians in West Massachusetts, and included a graphic of which states have the highest concentration, according to the ProPublica analysis, of doctors who take payments from industry.

Midwest

The Springfield News-Leader published an article about the two largest health systems in Springfield and how one system forbids physicians from meeting with industry at lunch time and the other system, which does not have such a policy in place. The article then went through the policies and whether a meal is considered a "gift or down payment," and how systems also differ on free drug samples.

Indiana Public Media published a story, using the same graphic as was found in the New England Public Radio blurb above, also outlining the database and what it found for physicians in Indiana, noting "almost three out of four doctors in Indiana took a payment from a drug or device maker" in 2014.

Wyandotte Daily Online published an article on Kansas City-area hospitals and the large variations from system to system in how many doctors "accept money from drug and medical device companies." The article surmised that "much of the variation has to do with hospital policies governing such payments and how well they're enforced."

Conclusion, Part II

The media bomb is the most recent showing in a string of actions taken by ProPublica that they are trying to "black list" those working with industry. Few, if any, of the articles included any rationale or reasons why such industry coordination is not a good thing. As we have seen, ProPublica and others disagree that the way to future innovation and new medicines and devices is not through collaboration, but instead believes it is beneficial to put in place more restrictions, leading to less cooperation and coordination.

May 12, 2016

We have been talking about the opioid addiction in America for several months now, from Congressional hearings, to new Centers for Disease Control (CDC) guidelines, to what solutions exist for patients and their loved ones. In response to the epidemic, CNN hosted a program entitled “Prescription Addiction,” hosted by Anderson Cooper and Dr. Sanjay Gupta.

The program featured guests including: addicts of opioids and heroin, family members of addicts who are no longer “themselves,” family members of addicts who have passed on due to their addictions, physicians, treatment center owners, and others, and was a question and answer session on the impact the epidemic has had on the country, and potential solutions.

Co-host Sanjay Gupta opened by calling the current opioid epidemic a “preventable” and “man made” epidemic. Dr. Leana S. Wen, the Baltimore City Health Commissioner, has been visible during many conversations on the epidemic, frequently speaks on the importance of doctors following guidelines and patients being involved in their medical care. During the special, she mentioned that patients should ask questions of their physicians, such as do I need this medication? What are the side effects? What are the alternatives available to me?

While many panelists and participants acknowledged that many doctors want to do the right thing, and do not go out of their way to perpetuate the epidemic, they focused on the idea that it is important that doctors review each individual patient and make a determination on whether or not to prescribe opioids based on individual situations, not general ideas.

Another reason behind the epidemic, and why America is disproportionately affected compared to the rest of the world, Dr. Wen believes, is that America is overprescribed. Patients are looking for a pill for every problem, and that culture needs to change before the opioid epidemic gets better. Dr. Wen as an emergency room physician tends to over simplify serious problems as there are many aspects to the opioid academic often left out of these discussions such as access to rehabilitation, alternative therapies, and the work being done to develop opioid alternatives.

Dr. Gupta believes, and other physicians agreed, that the FDA is in a tricky spot when it comes to this particular situation. That while they do need to continue approving more drugs, so patients have more options, they also act slowly when it comes to safety precautions. For example, they just recently approved black box warnings for certain drug classes.

Dr. Mark Rosenberg of St. Joseph’s, an opioid free provider, spoke to the fact that certain patients seek St. Joseph’s out specifically because of that policy. Such patients have either typically had an opioid addiction themselves, or have been personally affected by someone who has.

One solution idea to help those who are in the throes of addiction is to follow in the footsteps of Gloucester, MA. Gloucester’s police department allows addicts to come to the station, turn themselves and their drugs in, and instead of being taken into jail or criminally prosecuted, are helped and brought to addiction treatment centers. It takes a strong person to admit their addiction, but having a support system – and not one that throws them into jail – is an important step on the road to recovery. While it is important for police departments to be on this page, the program (including take back programs) should be modified to include pharmacies as locations for taking back drugs.

Additionally, several participants suggested that legislation against pill mills is not only common sense, but needs to be done sooner rather than later. A major concern by panelists and participants alike is the fact that some physicians (a small minority) are effectively glorified drug dealers. They engage in egregious behavior (beyond mere negligence or bad judgment), such as posting signs around the office that they are “Cash Only” and provide prescriptions and drugs without actually caring for the patient and evaluating their individual situation. The rationale behind prescribing opioids should always be to relieve the pain and suffering of the patient in front of them, after evaluating the options available for that patient.

Narcan/Naloxone are prescriptions that can help reverse an overdose from heroin or OxyContin. The prescriptions come in an an injection or a nasal spray, and can be helpful if a friend or family member is present when one is suffering from a narcotic overdose. However, the prescriptions are limited and need to be used shortly after the overdose signs appear. Even still, they have such a potential to save lives. Areas like New York actually allow the drug to be bought over the counter, and cities like Baltimore allow for a standing prescription for anyone who feels they need it.

The physicians acknowledged that while the DEA may be monitoring how many prescriptions physicians are writing, that isn’t the end of the story. Warnings from the health department tend to have no effect on the physicians who are engaging in the egregious behavior outlined above.

In sum, it is likely that this conversation will continue, with stakeholders and others continuing to speak on the topic. It is clear that this epidemic is troublesome, and that a solution is necessary. It is a matter of time to determine what those solutions may be, and how effective they truly are.

June 16, 2015

In April, the Centers for Medicare and Medicaid Services (CMS) released over thirty Medicare Part D payment spreadsheets, containing millions of lines of data. Interested patients can download the document containing their doctor’s last name, and find out how often he or she prescribed particular drugs to Medicare patients.

We have speculated for some time now that the trove of Medicare data would be paired with Open Payments data, both by journalists and potentially the government. Modern Healthcare indeed recently published an article correlating the two, entitled “Drugmakers funnel payments to high-prescribing doctors.”

The article includes an interactive tool to search for physicians who prescribed $500,000 or more of a drug and received money from the drugmaker. One such entry is for a doctor who prescribed approximately $600,000 worth of a drug and received $24 from that drug’s manufacturer.

The article also includes a “spotlight on potential conflicts,” which parses out the ten highest-prescribing Medicare physicians who are listed in the general payments database in Open Payments as receiving at least $5,000 from drug companies in 2013.

The article’s takeaway is that “about 23% of the 400-plus providers who prescribed $1 million or more of one drug received money from the maker of the drug.” What is interesting—even taking into consideration the small meals or often vital consulting or education agreements deemed to be “funneling” of funds—is that 23 percent is quite a low figure if you consider that “[m]ore than 90% of physicians report having some type of business relationship with industry sources.” (Modern Healthcare).

The article targets the Open Payments data and prescribing habits of Dr. Vallerie McLaughlin, an expert in cardiovascular disease, and Director of the Pulmonary Hypertension Program at the University of Michigan. She prescribed $4.8 million of the pulmonary arterial hypertension (PAH) treatment, Tracleer, and received $40,000 in consulting, travel, and meal fees from the Tracleer’s manufacturer, Actellion. The article does provide some balance, including quotes from Dr. McLaughlin. “It's in the best interest of clinical-care delivery for biomedical companies to be advised by the knowledgeable, experienced experts,” McLaughlin states. “I have treated PAH patients and have been involved in clinical trials in PAH for 20 years.”

Unfortunately, however, the article and others like it may be a disincentive for experts such as Dr. McLaughlin, who work in a specialized and very important field, to educate their peers on their area of expertise. The article is unclear about who would be better qualified from an academic or professional standpoint to teach others about hypertension treatment.

While there are certainly corrupt doctors who bill Medicare, the article’s implications that high prescribing doctors with payments in CMS’s Open Payments database are inherently unethical seems like the wrong approach. It not only has the potential to undermine the trust of patients in experts in a given specialty (which may lead to patients avoiding important treatments or not taking their medication), it also may silence doctors who should be educating their peers and patients on innovative new therapies.

The article notes that CMS has "cautioned that payments to providers from drugmakers and biotechnology companies don't necessarily mean there is a conflict of interest." The agency states: “Information about financial relationships alone is not enough to decide whether they're beneficial or improper...[j]ust because there are financial ties doesn't mean that anyone is doing anything wrong. Transparency will shed light on the nature and extent of these financial relationships and will hopefully discourage the development of inappropriate relationships.”

With the second year of Open Payments data due out at the end of the month, articles that simply list the top paid doctors will continue to proliferate. However, the impact of industry-physician collaborations--which result in tangible patient benefits--should be similarly easy to communicate.